DESCRIPTION: This grant will support researching and writing a book that describes and interprets the history of cardiology at the Mayo Clinic. It will also support recording oral histories of past and present staff members whose perspectives will inform the study and be a resource for future historians. Based on extensive research (including rich archival sources), my book will increase understanding of the roles academic centers played in the history of 20th century health care. Rather than a traditional institutional history of limited and local interest, this will be a detailed case study of the invention, growth and impact of one of the nation's oldest, largest and most influential cardiology programs. I will explain how the clinic and its cardiologists reacted to or catalyzed many changes in cardiac care. The focus on cardiology is significant: cardiovascular diseases cause 38.5 percent of all deaths and cost $350 billion annually in the U.S. The text will be organized in a blended chronological-thematic manner that worked well in my book American Cardiology. Now, I shift my focus from the professionalization of cardiology at a national level to heart care at a local level. My new book will illustrate how the care of cardiac patients at Mayo Clinic changed during the 20th century in response to a multitude of medical, scientific, technological, socioeconomic and organizational changes. Mayo became a world leader in patient care, education and research by combining an academic medical center model with a multi-specialty group practice structure that it helped invent. Over the decades Mayo's leaders made decisions about the content and context of patient care in response to many forces that shaped U.S. medicine. Meanwhile, cardiac care innovations diffused rapidly from academic centers to community hospitals; especially after World War II. Mayo cardiologists contributed significantly to this phenomenon with its important implications for patient access and health care costs. They influenced care elsewhere by lecturing and publishing frequently, by training hundreds of new specialists and by sponsoring regional, national and international continuing education programs. They also reported discoveries and new techniques that resulted from ambitious programs of basic, clinical and population research. Part of Mayo's success related to its encouragement of interdisciplinary collaboration (e.g. between cardiologists, heart surgeons, nurses, and scientists) and its emphasis on patient, physician and staff satisfaction.